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University at Buffalo

Mid-American Conference

ACADEMIC SERVICES

Student-Athlete Tutorial Program
Successful Students use Tutoring

Tutor Request Form

You will be notified by email when your appointment has been scheduled.

Date:

Student Information
Student Name:
Sport:
Email Address:
Phone:
Course Information
Course Name & No. (ex. UGC111):
Course Instructor:
Class Meets:
Do you attend class regularly? Yes No
If no, please state why:    
I need to meet with a tutor:
2-3 times per week
to review for tests only
once a week
1 time only
 
Additional Comments:
Statement of Understanding
I understand that, by being assigned a tutor for the course(s) requested, I am agreeing to meet with the tutor on an agreed upon schedule or as determined by my academic advisor. I have been advised of my responsibilities and I understand that failure to meet with the tutor can lead to the discontinuation of my tutoring services.
I Agree

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